Prevalence and Predictors of venous stenosis following first transvenous cardiac implantable electronic device implantation.

Objectives: Very few studies have been done on Venous stenosis following the first transvenous cardiac device implantation. We aimed to assess the prevalence and predictors of Venous stenosis/Occlusion following the first transvenous cardiac device implantation with venous angiography at one year of follow-up. Methods: This study was a single-center prospective, observational study. Demographic, clinical, procedural, and device data was collected. All patients underwent a preimplant contrast and repeated venography at twelve months to look for upper limb venous anatomy, obstruction, or collaterals. Results: A total of 146 patients were included in the final analysis. 60 (41 %) patients developed some degree of venous stenosis. Most patients had mild to moderate stenosis, and almost all were asymptomatic. Among patient-related factors increasing age (64.66±10.07 vs 60.91±11.94 years p=0.04), presence of hypertension (50.5% vs19.6% p=0.0004), diabetes (73% vs 29.6% p=0.000) and dyslipidemia (66.7% vs 36.3 p=0.009) were significantly associated with Venous stenosis/occlusion. Among procedure-related factors, larger total lead diameter (3.88± 1.09 vs. 3.50 ± 1.03 mm p=0.03) and implantation of biventricular devices(p=0.0037) seem to be significantly associated with venous obstruction. In logistic regression analysis, hypertension (p=0.018), total lead diameter(p=0.024), and use of CRT-P/CRTD/ICD (p=0.03) remained significant predictors of severe venous stenosis. Conclusions: Our study demonstrates venous obstruction in 40% of cardiac implantable electronic device patients at one-year follow-up. Most patients have mild to moderate stenosis, and almost all are asymptomatic. Increasing age, hypertension, diabetes, dyslipidemia, larger total lead diameter, and implantation of biventricular devices are significantly associated with venous obstruction.